Fetal Scalp Electrode Research Articles

CESAREAN AUDIT: USING ROBSON’S 10 GROUP CLASSIFICATION AT C. U. SHAH MEDICAL COLLEGE AND HOSPITAL

Objective: The World Health Organization (WHO) has expressed concern over the rising cesarean section (CS) rate, particularly in middle-and high- income countries. The reasons behind this increase are still debated, but the WHO declared that there is no justification for a rate higher than 10–15%. The Robson classification system, advocated by WHO and FIGO, can help assess and compare CS rates. Study Design and Methods: The Gynecology Department at C.U. Shah Medical College and Hospital conducted an observational study on pregnant patients hospitalized for labor pain between January 2020 and December 2022, with a focus on CS patients. The study used Robson’s 10-group categorization technique to extract maternal features and categorize cesarean performances. Results: Between January 2020 and December 2022, C. U. Shah Medical College and Hospital delivered 4967 patients, of whom 1,572 underwent a CS section. 46.3% were nulliparous, and 53.7% were multipara. 78.31% of patients arrived at full term, with 98.8% having single conceptions. 94.8% of the cases had a cephalic presentation, 4.4% had a breech presentation, and 0.81% had a transverse position. Conclusions: Robson classification is a useful technique for analyzing cesarean delivery (CS) rates, aiding in identifying corrective methods to reduce burden on healthcare systems, and promoting accurate labor monitoring, fetal scalp electrodes, and prenatal education.

Women's satisfaction with intrapartum fetal surveillance: A mixed-method study within the STan Australian randomised controlled trial (START)

BackgroundChildbirth satisfaction can impact short and long‐term health outcomes. In an Australian-first randomised controlled trial (RCT) (ACTRN1261800006268), two techniques for intrapartum fetal surveillance were compared; ST analysis (STan) as an adjunct to cardiotocography (CTG) compared to CTG alone. The aim was to determine if CTG+STan can reduce emergency caesarean section rates whilst maintaining or improving neonatal outcomes. This study compared women's experiences of and satisfaction with the two techniques of intrapartum fetal surveillance. MethodsN = 970 women were recruitment to the RCT between 2018 and 2021. We invited a consecutive sub-set of women (approximately the first half of the trial participants, n = 527) to complete a questionnaire at eight weeks postnatal. The analysis principle was intention to treat. ResultsOf the n = 527 invited women, n = 207 completed the questionnaire (n = 113/265, CTG+STan; n = 94/265, CTG alone). Birth satisfaction was similar in both arms. Women in the CTG+STan arm reported higher satisfaction with staff competency in monitoring and more likely to disagree that they would prefer different monitoring methods in future labours. Qualitative findings highlighted, the main perceived difference between techniques was the use of the fetal scalp electrode (FSE), always used with CTG+STan and when clinically necessary utilised with CTG. Women viewed the FSE positively, as it allowed for greater mobility. ConclusionsCTG+STan, provides comparable outcomes in terms of satisfaction with labour experience and monitoring. Findings should inform consumer-based information on electronic fetal surveillance, addressing common misconceptions among women and care providers about the potential use of a FSE. Trial registrationANZCTR, ACTRN1261800006268. Registered on 19 January 2018.

The impact of body mass index on labour management and mode of delivery: A retrospective matched cohort study.

This study aims to examine the association between body mass index (BMI) and mode of delivery, progression of labour, and intrapartum interventions. This was a retrospective matched cohort study including Class III obese (BMI ≥40 kg/m2) and normal BMI (BMI <25 kg/m2) women planning a vaginal birth who had a live, singleton delivery from January 2015 to December 2018. Patients were matched (1:1) based on age, gestational age, parity, onset of labour and birth weight. The primary outcome was caesarean delivery (CD). Secondary outcomes were delivery outcomes, intrapartum management and interventions. Rates of each outcome were compared with matched analysis, and duration of labour with time-to-event analysis. We studied two groups of 300 pregnant women. The CD rate was significantly higher for obese women than the normal BMI cohort (19.3% vs 13.3%; risk ratio (RR) 1.43, 95% CI 1.02-1.98, P = 0.035). Cervical dilation prior to CD for failure to progress was slower in obese than normal BMI (0.04 vs 0.16 cm/h). The obese cohort had a longer duration of labour in those who underwent induction (13.70 vs 11.48 h, P = 0.024). Intrapartum intervention rates were higher for obese women, with significant differences in rates of fetal scalp electrodes (72.7% vs 22.7%, RR 3.20, 95% CI 2.58-3.99, P < 0.001), intrauterine pressure catheters (18.3% vs 0%, P < 0.001), epidural analgesia (44.0% vs 37.0%, RR 1.20, 95% CI 1.01-1.44, P = 0.040) and fetal scalp lactate sampling (8.0% vs 3.0%, RR = 2.67, 95% CI 1.33-5.33, P = 0.004). Class III obesity is associated with an increased risk of CD and intrapartum interventions.

The fetal scalp electrode shortage is an urgent patient safety issue

There is currently a shortage of fetal scalp electrodes because of a recent recall due to concerns about the breakage of the electrode tip with possible injury to the neonate. Although the recall is presumably intended to improve safety, the resulting shortage of fetal scalp electrodes poses risks to patients because of inadequate fetal heart rate monitoring in cases where an adequate signal cannot be obtained with external fetal monitoring and/or when maternal heart rate artifact cannot be resolved by repositioning of transducers and application of a maternal pulse oximeter.

Maternal and peripartum risk factors for acute funisitis among term deliveries complicated by intraamniotic infection

Acute funisitis (AF), the histologic diagnosis of inflammation within the umbilical cord, represents a fetal inflammatory response and has been associated with adverse neonatal outcomes. There is little known regarding the maternal and intrapartum risk factors associated with the development AF among term deliveries complicated by intraamniotic infection (IAI). To identify maternal and intrapartum risk factors associated with developing AF among term deliveries complicated by IAI. After IRB approval, we conducted a retrospective cohort study of term deliveries affected by clinical IAI at a single tertiary center between 2013-2017 with placental pathology consistent with histologic chorioamnionitis. Exclusion criteria included intrauterine fetal demise, missing delivery information or placental pathology, and documented congenital fetal abnormalities. Maternal sociodemographic, antepartum, and intrapartum factors were compared among patients with AF on pathology to those without AF using bivariate statistics. Regression models developed to estimate adjusted odds ratios (aOR). Of 123 patients meeting inclusion criteria, 75 (61%) had AF on placental pathology. Compared to placental specimens without AF, AF was observed more frequently among patients with maternal body-mass-index (BMI) ≥ 30kg/m2 (58.7% vs, 39.6%, p=0.04) and labor courses with increased rupture of membrane (ROM) duration (17.3 vs, 9.6 hours, p=0.001). Use of fetal scalp electrode (FSE) was observed less frequently in AF (5.3% vs, 16.7%, p=0.04) compared to cases without AF. In regression models, maternal BMI≥30kg/m2 (aOR 2.67, 95% CI 1.21,5.90) and ROM >18 hours (aOR 2.48, 95% CI 1.07,5.75) were significantly associated with AF. FSE use (aOR 0.18, 95% CI 0.04,0.71) was negatively associated with AF. In term deliveries with IAI and histologic chorioamnionitis, maternal BMI≥30kg/m2, and ROM>18 hours were associated with AF on placental pathology. As insight into the clinical impact of AF grows, the ability to predict which pregnancies are at greatest risk for its development may allow for a tailored approach to predicting neonatal risk for sepsis and related comorbidity.

Clinical progress note: Evaluation and management of neonatal herpes simplex virus disease.

Clinical progress note: Evaluation and management of neonatal herpes simplex virus disease.

Neonatal eyelid penetration from insertion of a fetal scalp electrode: a case report

BackgroundA fetal scalp electrode (FSE), first described by Edward Hon in 1967, is an intrapartum monitoring device embedded directly into the fetal scalp for an accurate measure of fetal heart rate. Though use of an FSE is generally safe, complications can occur from misplacement, including ophthalmic injury.Case presentationPatient was a 28-year-old G6P5006 who presented for induction of labor at 39 weeks due to asymptomatic bilateral pulmonary embolism. Concerning findings on external fetal monitoring led to placement of a fetal scalp electrode for close monitoring. Upon delivery, the neonate was noted to have the FSE embedded in the left upper eyelid. Ophthalmology was consulted and could not rule out ocular injury on external examination at the bedside. Examination under anesthesia in the operating room demonstrated no penetration of the ocular globe, and the eyelid laceration was sutured. The laceration was well-healing at one-week follow-up with no further complications.ConclusionFacial or brow presentation during delivery is rare but may increase the risk for misplacement of an FSE. Ultrasound verification of vertex position is warranted immediately prior to placing an FSE for patients at higher risk of facial or brow presentation. Periorbital edema of neonates may protect against damage to deeper structures. However, Ophthalmology should be consulted to rule out ocular injury if the FSE is placed in the periocular region.

Experiences with intrapartum fetal monitoring in the Netherlands: A survey study

IntroductionWorldwide, cardiotocography is used for continuous monitoring of fetal heart rate (FHR) and uterine contractions during labour. Different methods for FHR registration and registration of contractions are available. Literature about the frequency of use of different fetal monitoring methods is lacking. ObjectiveTo evaluate the use of and preferences for fetal monitoring methods for intrapartum fetal monitoring among Dutch obstetric care providers. Study designBetween October and November 2020 the Dutch Society of Obstetrics and Gynaecology sent an email invitation to all secondary care midwives and gynaecologists (in training) in the Netherlands to complete an online survey regarding the use and personal experience with fetal monitoring methods. The survey mainly consisted of multiple choice questions. Descriptive statistics are reported. Continuous variables were presented as median with interquartile ranges (IQR). Categorical variables were expressed as numbers with percentages. ResultsThe response rate was 29 % (n/N = 510/1748). All Dutch hospitals were represented. The respondents estimated the use of fetal scalp electrode (FSE) at 71 % (IQR 58–85 %) of deliveries. The most common indication for use of the FSE was inadequate external FHR registration (94 %). More than half (54 %) of the respondents reported to use intrauterine pressure catheter with an estimated use of 5 % (IQR 2–8 %) of deliveries. The most common indication for use of intrauterine pressure catheter was inadequate external contraction registration (75 %). The use of ST-analysis was reported in 25 % of the respondents with an estimated use of 60 % (IQR 30–72 %) of deliveries. Almost all respondents (99 %) reported to use fetal blood sampling with an estimated use of 15 % (IQR 10–23 %) of deliveries. Ninety percent of respondents would prefer a valid and reliable external monitoring technique during labour. Thirty-one percent of respondents assume that external fetal monitoring with non-invasive fetal electrocardiography and electrohysterography will become standard care within the next 5 years. ConclusionsCurrently, the FSE is the most used technique for FHR monitoring during labour in the Netherlands. The most common indication for use of FSE is inadequate external FHR registration. Obstetric care providers would prefer a non-invasive external registration method that provides reliable data.

Quality of fetal heart rate monitoring with transabdominal fetal ECG during maternal movement in labor: A prospective study.

Transabdominal electrocardiographic (TAfECG) acquisition of fetal heart rate (FHR) signals has recently been introduced into leading commercial cardiotocographic (CTG) monitors. Continuous wireless transmission of signals has raised the possibility of the technology being used during maternal mobilization in labor. This study aims to evaluate signal quality and accuracy of TAfECG acquisition of FHR signals during static and active maternal positions in labor when compared with Doppler signals and with the gold-standard method of fetal scalp electrode (FSE). A total of 76 women with singleton term pregnancies in the active first stage of labor had simultaneously acquired FHR with TAfECG, Doppler, and FSE. Participants were asked to complete a supervised mobilization scheme, comprising five sequential 10-min periods of lying down, standing, sitting, walking, and rocking on the birthing ball. The three FHR signals were compared, defining signal loss as the percentage of signals under 20 bpm or exceeding 250 bpm and accuracy as the difference with FSE values. Computer analysis was used to quantify variability, accelerations, and decelerations. Static labor positions (lying down, standing, and sitting) were compared with active labor positions (walking and rocking on the birthing ball). Average signal loss was 5.3% with TAfECG (3.2% in static and 7.4% in active positions) and 15.5% with Doppler (8.3% in static and 30.7% in active positions). Average accuracy was 3.5bpm with TAfECG (1.9bpm in static and 5.04 bpm in active positions) and 13.9bpm with Doppler (3.2bpm in static and 24.7bpm in active positions). Average variability was similar with TAfECG and FSE in static positions but significantly higher with TAfECG in active positions (23.6 vs. 13.5 bpm, p < 0.001). In static labor positions, TAfECG provides a low signal loss, similar to that obtained with FSE, and a good signal accuracy, so the technique can be considered reliable when the mother is lying down, standing, or sitting. During maternal movement, TAfECG causes an artificial increase in FHR variability, which can cause false reassurance regarding fetal oxygenation. Doppler signals are unreliable during maternal movements.

Maternal Diabetes and Intrapartum Fetal Electrocardiogram.

Fetal electrocardiogram (ECG) ST changes are associated with fetal cardiac hypoxia. Our objective was to evaluate ST changes by maternal diabetic status and stage of labor. This was a secondary analysis of a multicentered randomized-controlled trial in which laboring patients with singleton gestations underwent fetal ECG scalp electrode placement and were randomly assigned to masked or unmasked ST-segment readings. Our primary outcome was the frequency of fetal ECG tracings with ST changes by the stage of labor. ECG tracings were categorized into mutually exclusive groups (ST depression, ST elevation without ST depression, or no ST changes). We compared participants with DM, gestational diabetes mellitus (GDM), and no DM. Of the 5,436 eligible individuals in the first stage of labor (95 with pregestational DM and 370 with GDM), 4,427 progressed to the second stage. ST depression occurred more frequently in the first stage of labor in participants with pregestational DM (15%, adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.14-4.24) and with GDM (9.5%, aOR 1.51, 95% CI 1.02-2.25) as compared with participants without DM (5.7%). The frequency of ST elevation was similar in participants with pregestational DM (33%, aOR 0.79, 95% CI 0.48-1.30) and GDM (33.2%, aOR 0.91, 95% CI 0.71-1.17) as compared with those without DM (34.2%). In the second stage, ST depression did not occur in participants with pregestational DM (0%) and occurred more frequently in participants with GDM (3.5%, aOR 2.01, 95% CI 1.02-3.98) as compared with those without DM (2.0%). ST elevation occurred more frequently in participants with pregestational DM (30%, aOR 1.81, 95% CI 1.02-3.22) but not with GDM (19.0%, aOR 1.06, 95% CI 0.77-1.47) as compared with those without DM (17.8%). ST changes in fetal ECG occur more frequently in fetuses of diabetic mothers during labor. gov number, NCT01131260. ST changes in fetal ECG, a marker of fetal cardiac hypoxia, occur more frequently in fetuses of diabetic parturients. · Fetal hypertrophic cardiomyopathy (HCM) and cardiac dysfunction occur frequently among fetuses of diabetic patients.. · Fetal ECG changes such as ST elevation and depression reflect cardiac hypoxia.. · Fetuses of diabetic patients demonstrate a higher prevalence of fetal ECG tracings with ST changes..

Fetal scalp electrode use

Fetal scalp electrodes are a common intervention in the UK, in circumstances where monitoring via an abdominal transducer is ineffective. However, there are cases in which a fetal scalp electrode does not ensure continuous transmission of the fetal heart rate, and its application and continued presence can cause distress and discomfort to the birthing person. Research reveals that fetal scalp electrodes are associated with neonatal morbidity and mortality, as well as maternal infection. Given the limitations of continuous fetal monitoring, the author posits that the use of these devices should only occur with clear clinical indications and fully informed consent from the birthing person.

Safety of Internal Electronic Fetal Heart Rate Monitoring During Labor

Abstract Objective: To investigate the safety and efficacy of internal electronic fetal heart rate (FHR) monitoring during labor. Methods: This was a retrospective case-control study, which was an analysis of monitoring FHR with a fetal scalp electrode or a Doppler probe (94 pregnant women per group). In the internal monitoring group, when the opening of the uterine orifice was ≥3 cm, the fetal scalp electrode was placed after natural or artificial rupture of the membrane. FHR was simultaneously monitored using a Doppler probe. In the external monitoring group, continuous FHR monitoring was performed using an ultrasound Doppler transducer fixed on the maternal abdomen. The toco transducer was used to record uterine contractions. Pathological examination of the placenta was performed prospectively in 49 and 48 cases in the internal electronic FHR monitoring group and control group, respectively. Maternal-infant outcomes (e.g. fever, puerperal infection, puerperal morbidity, delivery mode, Apgar score, and scalp injury) were recorded. Umbilical artery blood was extracted for blood gas analysis. Differences between the two groups were compared using the paired t-test, χ 2 test, Yates corrected χ 2 test or Fisher exact test. Results: Non-statistically significant differences between the internal and external monitoring groups were observed in the incidence of neonatal acidosis (1/94 (1.06%) vs. 3/94 (3.19%), respectively; χ 2 = 0.255, P = 0.613), cesarean section/operative vaginal delivery (8/94 (8.51%) vs. 15/94 (15.96%), respectively; χ 2 = 2.427, P = 0.181), fever during labor (18/94 (19.15%) vs. 15/94 (15.96%), respectively; χ 2 = 0.331, P = 0.565), puerperal morbidity (2/94 (2.13%) vs. 3/94 (3.19%), respectively; χ 2 = 0.000, P = 1.000), chorioamnionitis (9/49 (18.37%) vs. 7/48 (14.58%), respectively; χ 2 = 0.252, P = 0.616), and neonatal asphyxia (0/94 (0.00%) vs. 1/94 (1.06%), respectively; χ 2 = 0.000, P = 1.000). There were no puerperal infections, neonatal scalp injuries, or scalp abscesses found in either group. Using the internal monitoring value as reference, the incidence of FHR false deceleration in external FHR monitoring was 20.21% (19/94 women). Conclusion: Internal FHR monitoring during labor does not increase the incidence of adverse perinatal outcomes. External monitoring was associated with FHR false decelerations.

An Unexpected Cause of Recurrent Fetal Decelerations

An Unexpected Cause of Recurrent Fetal Decelerations

A Novel Approach to Teaching the Cervical Exam: A Versatile, Low-Cost Simulation for Labor and Delivery Learners.

This technical report describes the making of cervical exam models that can be used to teach cervical dilation and effacement, with the versatility to teach additional obstetrical skills including artificial rupture of membranes (AROM) and fetal scalp electrode (FSE) placement. These models, primarily constructed from materials that are low cost and/or easily accessible within a healthcare setting, can be used to educate nurses, medical students, residents, and other healthcare professionals to improve the evaluation of the labor progress.

Use of Methadone Maintenance Therapy for Opioid Use Disorder in Pregnancy.

Use of Methadone Maintenance Therapy for Opioid Use Disorder in Pregnancy.

Case 2: Early-Onset Neonatal Sepsis in a Term Neonate

Case 2: Early-Onset Neonatal Sepsis in a Term Neonate

Neonatal brain abscess development following fetal scalp electrode placement: a rare complication

A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient developed a very large brain abscess after initial superficial infection of the skin site due to an FSE. The patient was admitted to the hospital after an asymmetric growth of the skull was noticed with no further signs of clinical illness. MRI showed a very large brain abscess which was aspirated and treated with antibiotics for 10 weeks. A 2-year follow-up showed only a slight developmental delay in gross motor skills. Only once before a similar case has been described at which the patient developed a brain abscess after superficial infection of the scalp following an FSE. In both cases, the brain abscess was noticed due to an asymmetric growth of the skull without any further signs of clinical illness. A brain abscess has a high mortality and morbidity rate, and early diagnosis is vital for the optimal outcome. We therefore recommend to organize an out-patient clinical follow-up for every infant with a superficial infection of the skin site after placement of an FSE.

398 The impact of BMI on management of labour: A retrospective matched cohort analysis

Maternal obesity is a major challenge to safe obstetric practice with higher rates of intrapartum complications, failed induction of labour (IOL) and emergency caesarean delivery (CD). We investigated the impact of obesity on labour outcomes and interventions. Class III obese (BMI >40 Kg/m2) and normal BMI (<25 Kg/m2) patients who delivered from 2015-2018 were matched (1:1) based on age, gestational age, parity, onset of labour, and birth weight. Patients with previous CD, IOL < 37 weeks, maternal age <18 years or stillbirth were excluded. The primary outcome was CD. Secondary outcomes were instrumental delivery, cervical dilation at decision for CD, dilation rate prior to decision for CD for labour progress, oxytocin augmentation, and intrapartum interventions (epidural analgesia, fetal scalp electrode (FSE), intrauterine pressure catheter (IUPC), fetal scalp lactate, terbutaline use). Of 600 matched patients, 50% were primigravidae (PG). Half of both PG and multigravidae groups underwent IOL. CD rate was higher for obese (oBMI) patients (19.3%) than the normal BMI (nBMI) cohort (13.3%, RR 1.45, CI 1.00-2.09, p = 0.049). Instrumental deliveries occurred less in oBMI (16.7%) than with nBMI (24.0%, RR 0.89, CI 0.50-0.96, p = 0.027). Median cervical dilation at CD was lower for oBMI (4 cm) than nBMI (6 cm), even when comparing only CD for poor progress (5 cm vs 7 cm). Rate of dilation prior to CD for poor progress was lower in oBMI (0.04cm/hr) than nBMI (0.16cm/hr). In CD patients, oxytocin was used less often for oBMI (75.8% vs 85.0%, RR 0.89, CI 0.73-1.08, p = 0.253) but with a higher mean total dose (12.3 IU vs 11.9 IU). Rates of intrapartum intervention were higher for oBMI, particularly FSE (72.7% vs 22.7%, RR 3.21, CI 2.52-3.99, p < 0.001) and IUPC (55% vs 0%, p < 0.001). Obesity increased the risk of CD, and CD for poor progress occurred at a lower cervical dilation in the obese cohort, with a slower rate of dilation prior to CD. Intrapartum interventions occurred more in the obese cohort.

Non-Invasive Fetal Electrocardiogram Extraction Based on Novel Hybrid Method for Intrapartum ST Segment Analysis

This study focuses on non-invasive fetal electrocardiogram extraction based on a novel hybrid method, which combines the advantages of non-adaptive and adaptive approaches for non-invasive fetal electrocardiogram morphological analysis. Besides estimating fetal heart rate, which is the main parameter used in the clinical practice, this study provides non-invasive ST segment analysis on data from Abdominal and Direct Fetal Electrocardiogram Database consisting of simultaneous traditional - gold standard invasive fetal scalp electrode and non-invasive fetal electrocardiogram recorded during delivery. This innovative approach utilizing the combination of independent component analysis and recursive least squares algorithms has the potential to extract valuable information from non-invasive fetal electrocardiogram in order to identify eventual sign of fetal distress. This was a prospective observational study of non-invasive fetal electrocardiogram, using 4 abdominally sited electrodes, against the traditional fetal scalp electrode on 8 patients. In terms of fetal heart rate estimation, the accuracy was high for all 8 tested patients with average value equaled 0.20 beats per minute and average value of 1.96 standard deviation equaled 5.80 beats per minute. In 7 patients, it was possible to perform the ST segment analysis with high accuracy in determining T/QRS in comparison with the reference fetal scalp electrode signal with average values and 1.96 standard deviation equaled 0.008 and 0.031 respectively. This study thus demonstrates that ST segment analysis is feasible using non-invasive fECG using the proposed hybrid method.

Internal fetal and uterine monitoring in obese patients and maternal obstetrical outcomes

The maternal habitus in the setting of obesity makes external monitoring of the fetal heart rate and contractions suboptimal, and internal monitors may be utilized more often in this population. Obesity is a risk factor for obstetrical infectious complications, but it is unknown whether the use of internal monitors in this population is associated with additional risks. This study aimed to investigate the association between the use of an intrauterine pressure catheter and a fetal scalp electrode and maternal infectious morbidity among women with obesity. This secondary analysis of a prospective cohort study included women with singleton gestations admitted for labor at ≥37 weeks' gestation at a tertiary care institution from 2010 to 2014. Obesity was defined as a body mass index of ≥30 kg/m2. The primary outcome was a composite maternal infectious morbidity, which included peripartum maternal fever, chorioamnionitis, and endomyometritis. Secondary outcomes were cesarean delivery and individual components of the maternal infectious composite. Multivariable logistic regression was used to compare the rates of infectious maternal morbidity, cesarean delivery, or operative vaginal delivery between patients with and without internal monitors, while adjusting for the confounders. An interaction term was included in the logistic regression models to test whether the relationship between the internal monitors and cesarean delivery or infectious morbidity was modified by the presence or absence of obesity. Of the 8482 women who met the inclusion criteria for the study, 4727 (55.7%) had obesity and 3755 (44.3%) did not have obesity. The women with obesity were more likely to have internal monitors placed during labor than those without obesity (65.4% vs 50.5%; P<.001). The use of internal monitors was associated with an increased risk for the composite maternal infectious morbidity (9.9% vs 4.1%; P<.01 and adjusted odds ratio, 2.08; 95% confidence interval, 1.70-2.55). Women with obesity had a weaker association between the use of internal monitors and maternal infectious morbidity than women without obesity (P value for interaction of .02). The incidence of cesarean delivery was also significantly higher among women who had internal monitors placed during their labor course (adjusted odds ratio, 2.84; 95% confidence interval, 2.46-3.28), and this interaction was not modified by obesity. Although a higher proportion of women with obesity have internal monitors placed during their labor course, they are not more susceptible to maternal infectious morbidity as a result of internal monitor use. Providers should not limit the necessary internal monitor use in women with obesity on the basis of concerns for maternal infectious morbidity.